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Presented by Ashley Cimino-Mathews, M.D. and prepared by Mark Samols, M.D., Ph.D.
Case 2: A 60 year-old male present with a splenic mass.
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1. Question
Week 549: Case 2
A 60 year-old male present with a splenic massimages/samols/0304132a.jpg
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images/samols/0304132e.jpgCorrect
Answer: Sclerosing angiomatoid nodular transformation
Histology: The splenic lesion has a multinodular appearance with variably sized nodules containing splenic sinuses (red pulp), separated by bands of dense fibrosis. The slit-like vascular spaces within the nodules are lined by plump endothelial cells with no atypia. The intervening fibrous areas contain bland spindled cells.
Discussion: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a mass forming lesion first described in 2004. The individual nodules contain the various small vessels comprising normal splenic red pulp, that is: capillaries, sinusoids and small veins, each with a unique immunohistochemical profile [cord capillaries are CD34+/CD8-/CD31+, sinusoids are CD34-/CD8+/CD31+, and small veins are CD34-/CD8-/CD31+]. In contrast, splenic littoral cell angiomas and hemangiomas consist of a proliferation on one individual vessel type. Regardless, immunohistochemistry is not necessary to make the diagnosis of SANT. The low power impression of multiple nodules of splenic red pulp separated and encircled by fibrous bands is highly suggestive of SANT. SANT is considered to be a nonneoplastic process, and splenectomy is curative.
Reference(s):
– Martel M, Cheuk W, Lombardi L, Lifschitz-Mercer B, Chan JK, Rosai J. Sclerosing angiomatoid nodular transformation (SANT): report of 25 cases of a distinctive benign splenic lesion. Am J Surg Pathol. 2004;28(10):1268-79.Incorrect
Answer: Sclerosing angiomatoid nodular transformation
Histology: The splenic lesion has a multinodular appearance with variably sized nodules containing splenic sinuses (red pulp), separated by bands of dense fibrosis. The slit-like vascular spaces within the nodules are lined by plump endothelial cells with no atypia. The intervening fibrous areas contain bland spindled cells.
Discussion: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a mass forming lesion first described in 2004. The individual nodules contain the various small vessels comprising normal splenic red pulp, that is: capillaries, sinusoids and small veins, each with a unique immunohistochemical profile [cord capillaries are CD34+/CD8-/CD31+, sinusoids are CD34-/CD8+/CD31+, and small veins are CD34-/CD8-/CD31+]. In contrast, splenic littoral cell angiomas and hemangiomas consist of a proliferation on one individual vessel type. Regardless, immunohistochemistry is not necessary to make the diagnosis of SANT. The low power impression of multiple nodules of splenic red pulp separated and encircled by fibrous bands is highly suggestive of SANT. SANT is considered to be a nonneoplastic process, and splenectomy is curative.
Reference(s):
– Martel M, Cheuk W, Lombardi L, Lifschitz-Mercer B, Chan JK, Rosai J. Sclerosing angiomatoid nodular transformation (SANT): report of 25 cases of a distinctive benign splenic lesion. Am J Surg Pathol. 2004;28(10):1268-79.
